Abstract
Published data suggest that there are increased hospitalizations, placental abnormalities, and rare neonatal transmission among pregnant women with coronavirus disease 2019 (COVID-19). To evaluate adverse outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy and to describe clinical management, disease progression, hospital admission, placental abnormalities, and neonatal outcomes. This observational cohort study of maternal and neonatal outcomes among delivered women with and without SARS-CoV-2 during pregnancy was conducted from March 18 through August 22, 2020, at Parkland Health and Hospital System (Dallas, Texas), a high-volume prenatal clinic system and public maternity hospital with widespread access to SARS-CoV-2 testing in outpatient, emergency department, and inpatient settings. Women were included if they were tested for SARS-CoV-2 during pregnancy and delivered. For placental analysis, the pathologist was blinded to illness severity. SARS-CoV-2 infection during pregnancy. The primary outcome was a composite of preterm birth, preeclampsia with severe features, or cesarean delivery for abnormal fetal heart rate among women delivered after 20 weeks of gestation. Maternal illness severity, neonatal infection, and placental abnormalities were described. From March 18 through August 22, 2020, 3374 pregnant women (mean [SD] age, 27.6 [6] years) tested for SARS-CoV-2 were delivered, including 252 who tested positive for SARS-CoV-2 and 3122 who tested negative. The cohort included 2520 Hispanic (75%), 619 Black (18%), and 125 White (4%) women. There were no differences in age, parity, body mass index, or diabetes among women with or without SARS-CoV-2. SARS-CoV-2 positivity was more common among Hispanic women (230 [91%] positive vs 2290 [73%] negative; difference, 17.9%; 95% CI, 12.3%-23.5%; P < .001). There was no difference in the composite primary outcome (52 women [21%] vs 684 women [23%]; relative risk, 0.94; 95% CI, 0.73-1.21; P = .64). Early neonatal SARS-CoV-2 infection occurred in 6 of 188 tested infants (3%), primarily born to asymptomatic or mildly symptomatic women. There were no placental pathologic differences by illness severity. Maternal illness at initial presentation was asymptomatic or mild in 239 women (95%), and 6 of those women (3%) developed severe or critical illness. Fourteen women (6%) were hospitalized for the indication of COVID-19. In a large, single-institution cohort study, SARS-CoV-2 infection during pregnancy was not associated with adverse pregnancy outcomes. Neonatal infection may be as high as 3% and may occur predominantly among asymptomatic or mildly symptomatic women. Placental abnormalities were not associated with disease severity, and hospitalization frequency was similar to rates among nonpregnant women.
Highlights
By September 7, 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had infected more than 27 million people worldwide.[1]
In a large, single-institution cohort study, SARS-CoV-2 infection during pregnancy was not associated with adverse pregnancy outcomes
Among all delivered women diagnosed with SARSCoV-2 during pregnancy, we evaluated trimester of diagnosis and neonatal SARS-CoV-2 results according to maternal illness severity
Summary
By September 7, 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had infected more than 27 million people worldwide.[1] Data in pregnancy are still emerging. Preliminary evidence suggests that adverse pregnancy outcomes, such as preterm birth, preeclampsia, and cesarean delivery, are higher in women with confirmed SARS-CoV-2 infection during pregnancy, few large-scale studies have been conducted with sufficient power to evaluate risk for specific adverse outcomes.[7] Abnormal placental findings have been reported with specific concerns for placental vasculopathy and inflammatory infiltrates.[8,9] The aims of our study were to conduct a comprehensive evaluation of adverse pregnancy outcomes associated with SARS-CoV-2 infection in pregnancy and to describe clinical management, maternal disease severity and clinical progression, hospital admission, placental abnormalities, and neonatal outcomes at a high-volume, urban maternity care center with widespread access to SARS-CoV-2 testing
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